Video Archives

Men with High-Risk Prostate Cancer Should Not Undergo Neoadjuvant Therapy Prior to Surgery

Posted by David Utz | Apr 2021

J. Kellogg Parsons MD, MHS, FACS, Professor of Urology at the University of California, San Diego, explains why neoadjuvant therapy prior to surgery may not be the best option for prostate cancer patients. He reviews findings from definitive randomized clinical trials that show ADT does not improve survival, and addresses common side effects, such as cognitive impairment and loss of testosterone function. Dr. Parsons then explains AUA Clinical Guidelines published in alignment with SUO and ASTRO that strongly recommend against routine neoadjuvant therapy prior to surgery. Lastly, he gives examples of when physicians can consider the option despite such caveats.

17 Inches: A Baseball Metaphor That Has Healthcare Implications

Posted by Neil H. Baum, MD | Apr 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, offers advice on maintaining standards in a medical practice. He provides common examples from physician lateness to addressing after-hours patient calls for routine medication refills. Instead of “widening the plate” as the baseball metaphor goes, Dr. Baum insists that doctors must hold themselves accountable to the same standards as those they serve. For example, if a doctor is consistently late, thereby requiring staff to make excuses for them, they should consider whether they would accept such behavior from a patient. Or if a payor denies a request for a procedure or medication based on a prior authorization requirement, should the doctor continue to accept this payor knowing that they may create additional work and future delays? Dr. Baum proposes physicians maintain their standards instead of modifying their protocols or behavior to accommodate others.

Brachytherapy and Focal Therapy Outcomes

Posted by Richard G. Stock, MD | Apr 2021

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, discusses focal therapy and brachytherapy. He outlines the rationale for focal therapy, reviews patient selection, and provides an extensive evaluation of the supporting evidence. For the small percentage of patients that may not have bilateral, multifocal disease, partial gland treatment can reduce morbidity and leave open future partial gland treatment options, should they become necessary. In general, patients in most studies examining focal therapy have unilateral disease, an MRI detectable lesion, Gleason score of <=7, and PSA <= 10ng/ml. Dr. Stock considers the types of focal therapy such as cryotherapy, high-intensity focused ultrasound (HIFU), and brachytherapy, highlighting the importance of treating the margin surrounding the tumor in any focal therapy. He then describes focal low dose rate brachytherapy and provides recommendations including a preplan and real-time ultrasound to ensure accuracy and minimize side effects. Lastly, Dr. Stock reviews data analyzing changes in morbidity, erectile function, and quality of life in whole gland and hemigland treatment plans.

Laparoscopic Radical Cystectomy (LRC) and Intracorporeal Urinary Diversion (ICUD)

Posted by Pengfei Shao, MD | Apr 2021

Pengfei Shao, MD, Associate Professor and Chief Physician of Urology at First Affiliated Hospital of Nanjing Medical University, discusses both laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD) operations and the ability of robotics, through the endoscopic stapler, to assist physicians with ICUD. He discusses the history of LRC as well as a step-by-step outline of performing both procedures. Dr. Shao also compares ICUD to endoscopic urinary diversion, with data showing that while the two procedures have similar outcomes, ICUD has lower rates of complications. He also discusses the technical difficulties of the procedures, noting the risk of developing neobladder stones from the procedure. Following the lecture is a brief Q&A with GRU Asian Series Editor Peter K.F. Chiu, MD, PhD, FRCSEd.

Neoadjuvant Trials in High Risk Prostate Cancer: A Must Do for the Field

Posted by Robert E. Reiter, MD, MBA | Apr 2021

Robert E. Reiter, MD, MBA, Bing Professor of Urology and Molecular Biology and Director of the Prostate Cancer Treatment and Research Program at the David Geffen School of Medicine at the University of California, Los Angeles, and Principal Investigator of UCLA’s SPORE (Specialized Program in Research Excellence) program, argues for supporting neoadjuvant trials in high-risk prostate cancer as a key way to improve treatment results. He explains that ⅓ of high-risk patients die from their cancer, citing this as evidence that high-risk prostate cancer management must improve. Dr. Reiter then reviews several trials, beginning with CaLGB 90203, a neoadjuvant chemohormonal therapy study which found that over the course of ten years neoadjuvant patients experienced an 80% survival probability, while patients who were treated with only surgery experienced a 74% survival probability. He analyzes an assortment of phase II trials exploring whether more intensive androgen ablation can improve the short-term results of, for example, pathologic complete responses. These trials found that the complete response rates increased from 4% to 14% over the course of 12 weeks with no biochemical recurrences. Dr. Reiter continues by drawing attention to the current phase 3 PROTEUS trial, which should clarify whether or not pathologic complete response is a valid endpoint. He concludes with a discussion of the beneficial findings of pure translational neoadjuvant studies.